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Original Article Application of Omaha System-Based Extended Care in Children with Severe Viral Encephalitis and Limb Hypofunction

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Original Article Application of Omaha System-Based Extended Care in Children with Severe Viral Encephalitis and Limb Hypofunction Int J Clin Exp Med 2020;13(6):4282-4290 www.ijcem.com /ISSN:1940-5901/IJCEM0109202 Original Article Application of Omaha system-based extended care in children with severe viral encephalitis and limb hypofunction Lili Sun1*, Demiao Yang2*, Sisi Shao3, Li Zhang2, Lili Kong4 1Department of Otorhinolaryngology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, China; 2Supply Room, Departments of 3Ophthalmology, 4Pediatrics, Shandong Zaozhuang Maternity and Child Health Care Hospital, Zaozhuang, Shandong Province, China. *Equal contributors and co-first authors. Received February 14, 2020; Accepted March 18, 2020; Epub June 15, 2020; Published June 30, 2020 Abstract: Objective: To explore the effect of Omaha system-based extended care in children with severe viral en- cephalitis (SVE) complicated with limb hypofunction. Methods: In this prospective study, 82 children with SVE com- plicated with limb hypofunction were selected and divided into two groups according to a random number table method: Omaha group (n=43, Omaha system-based extended care) and control group (n=39, routine extended care). The following indicators between the two groups were compared, including total nursing effectiveness, dis- ability rate, recovery time of limb disorders, nursing satisfaction, Fugl-Meyer assessment (FMA) scores at hospital discharge (before nursing), 1 month and 3 months after hospital discharge (after nursing), and Pediatric Quality of Life Inventory (PedsQLTM 4.0) Generic Core Scale scores. Results: Children in the Omaha group had significantly higher nursing effectiveness compared with the control group (88.37% vs. 69.23%, P<0.05), lower disability rate (4.65% vs. 20.51%, P<0.05), shorter recovery time of limb disorders (11.46±2.78 d vs. 16.33±3.87 d, P<0.0001), and higher item scores and total scores of nursing satisfaction (service attitude, professional skills, health educa- tion, psychological counseling, and case management) (all P<0.0001). FMA scores in the two groups at 1 month and 3 months after nursing were increased compared with those before hospital discharge (all P<0.05), and FMA scores at all stages after nursing in the Omaha group were better than those in the control group (all P<0.01). Physiology, emotion, society, role and total scores of PedsQLTM 4.0 in the two groups were increased at 1 month and 3 months after nursing (all P<0.05), and each score at all stages after nursing in the Omaha group was higher than that in the control group (all P<0.05). Conclusion: Omaha system-based extended care can improve the motor function and quality of life of children with SVE complicated with limb hypofunction, effectively control the disability rate, and increase nursing satisfaction of children’s families; all of which are worthwhile to popularize and apply. Keywords: Omaha system, extended care, severe viral encephalitis, limb function, quality of life Introduction ally carried out within the hospital, and routine in-hospital care is given during the treatment. Severe viral encephalitis (SVE) is a central ner- However, the critical period for disease recov- vous system infectious disease caused by ery is 1-3 months after hospital discharge. enterovirus, herpes simplex virus and other Therefore, it is vital to treat patients with timely common infectious viruses [1]. When SVE and effective extended care when the care is occurs in children, pathological changes are transferred from the hospital to the home [3]. manifested as brain parenchyma necrosis, malacia or hemorrhage, which further triggers The Omaha system is a simplified standardi- obstacles to limb movement, language function zed nursing language system, which has been weakening, secondary epilepsy and other developed and improved since it was estab- sequelae; severe SVE can lead to mental retar- lished in the United States in 1975, and has dation, acroparalysis etc., with a disability rate been recognized and proved by many service as high as 20% [2]. The treatment of SVE is usu- institutions in many countries for its scientific- Omaha system-based extended care in SVE combined with limb hypofunction ness, effectiveness and applicability [4]. In besides SVE; children had congenital disease addition to clinical nursing, the areas of appli- or other chronic progressive diseases. cation after its introduction in China include education, scientific research and others. At Methods present, the Omaha system is mostly used for the nursing of patients with chronic diseases or Children in the control group were given medi- community patients in clinical practice, while it cation guidance and precautions at hospital is seldom used for the nursing of pediatric dis- discharge and received routine extended care eases. Previous study has found that when the after hospital discharge; regular telephone fol- Omaha system is applied to diseases that low-up began at 1 week after hospital discharge require extended care, it can improve the over- to follow the current physical symptoms, reha- all nursing for patients and their quality of life bilitation status, diet and daily activities of chil- [5]. Although the survival rate of children with dren, and health guidance was given and SVE increases with the development of the recorded according to the specific conditions. level of intensive care medicine in China, it is Home visits were arranged and recorded at 1 still a long way to recover from sequelae after month after hospital discharge. treatment; this is an urgent and difficult prob- lem to be solved in clinical nursing of this dis- Children in the Omaha group received Omaha ease [6]. In view of the particular stages of the system-based extended care in addition to care recovery of children with SVE, Omaha system- received in the control group. Details were as based extended care was applied to 3-month follows. out-of-hospital nursing for children in this study, Establishment of Omaha nursing team to explore the effect of this nursing model on prognostic recovery in SVE children with motor The team members included a chief physician, dysfunction. a head nurse, a nursing postgraduate student, Materials and methods a psychotherapist, a physical therapist, and several clinical nurses. All team members had General data more than 5 years of work experience in pediat- rics except the nursing postgraduate. All team In this prospective study, 82 children with SVE members were trained and passed relevant complicated with limb hypofunction who were examinations. The training methods included admitted to Shandong Zaozhuang Maternity expert instruction and online video courses. and Child Health Care Hospital from June 2017 to May 2019 were selected and divided into Nursing problems classification two groups according to a random number table method: Omaha group (n=43, Omaha At 3 d before hospital discharge, children were system-based extended care) and control assessed by reference to environment, social group (n=39, routine extended care). This study psychology, physiology, and health behavior of was approved by the Ethics Committee of the Omaha system, including a total of 42 guid- Shandong Zaozhuang Maternity and Child ance survey questions; according to the specif- Health Care Hospital. ic symptoms of children after assessment, the nursing problems were determined and the Inclusive criteria: Diagnostic criteria for SVE in intervention direction was formulated [8]. For Pediatrics Ninth Edition published by the children facing multiple nursing problems at People’s Medical Publishing House were met the same time, Maslow’s hierarchy of needs [7]; children were accompanied by limb hypo- was adopted according to the individual needs function, with the Fugl-Meyer assessment and symptoms of children, to prioritize each (FMA) score of <50; children were 2-11 years nursing problem before intervention. old; children’s families had normal communica- tion skills and no dyslexia; children’s families Development of intervention measures agreed and signed the informed consent form. Based on the nursing process of the Omaha Exclusive criteria: Children were complicated system, the above nursing problems were sub- with other central nervous system diseases classified into 76 intervention directions in 4283 Int J Clin Exp Med 2020;13(6):4282-4290 Omaha system-based extended care in SVE combined with limb hypofunction terms of four nursing practices: health educa- At the 1st month after hospital discharge, a tion guidance and consultation, treatment pro- home visit was performed to provide familial cedures, case management and monitoring [9]. guidance face to face. The results of measured Then intervention directions were summarized items within 1 month were assessed, such as and adjusted to formulate an extended care the scores of motor function and quality of life. plan suitable for SVE children in our hospital. The feasibility of current nursing pattern, Details were as follows. whether to continue the plan, and whether pre- vious nursing problems had been solved were On the day of hospital discharge, health records weighed. The nursing effect at this stage was of all children were completed, including the evaluated. If other nursing problems appeared, time of first onset, the time of first diagnosis, a corresponding intervention strategy was for- prodromal symptoms, all inspection reports mulated according to the children’s symptoms. and nursing measures. Discharge instruction was then performed through multimedia, and At the 2nd month after hospital discharge, nurs- the video presentation content included rou- ing continued. Telephone follow-up or home tine symptom identification and management, visit was carried out to record the current health medication guidance, and precautions of diet, status of children, track nursing implementa- exercise and rest. The families were informed tion of children’s families and determine nurs- to record the health status of children on time ing progress. at home for doctor’s review at the subsequent visit. At the 3rd month after hospital discharge, the above nursing process were continued, and the The physical therapist instructed the families to final nursing effect was assessed.
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